Medicare Advantage plans seem to be popular. But why? What is the appeal? What is so attractive about these managed care plans? Are they really free? GA Medicare expert Bob Vineyard explains.
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Why are GA Medicare Advantage Plans Popular
Are you turning 65 and confused about the Medicare process? Why is it so difficult? Why do my friends, and many agents as well, want to push me in the direction of an Advantage plan? Low premiums are attractive. So is “free”. Is there really such a thing as a free lunch?
Medicare Advantage plans are like the Hotel California. You can check in but you may never leave.
Some people turn to Advantage plans when they first go on Medicare at age 65. Low premiums, many are $0. Extra benefits like dental, vision and some have gym memberships. Drug plans are often included in the plan. “One stop shopping”.
What’s not to love?
Georgia Advantage Plan Traps
Have you ever bought something and later realized you had no idea how it works? Maybe the sales person forgot to mention key details that might have changed your decision.
If something is too good to be true it probably is.
There is nothing inherently wrong with GA Medicare Advantage plans. You just need to understand what you have signed on for. Here are a few questions you need to ask.
Preferably BEFORE you enroll.
- Is the plan a PPO or HMO?
- Do I need a referral to see a specialist?
- Will my doctor take my Medicare Advantage plan?
- Are there any out of network penalties?
- Can I change plans at any time?
- Can I return to original Medicare and a supplement plan if I want?
- Does the out of pocket limit include prescription medication?
- What will my health care really cost if I use an out-of-network doctor?
- Will my claims be paid if I use a non-par provider?
If you ask the right questions and are satisfied with the responses, the Medicare Advantage plan could be just what you need.
When you enroll in a managed care Advantage plan, the insurance carrier, not Medicare, provides your benefits then reviews, adjudicates and pays your claims.
“No premium” plans are not free. You still have to pay for health care and prescription drugs.
There is no free lunch.
Health care is not free. SOMEBODY pays the bill. Either you or the insurance carrier.
But you knew that all along, didn’t you?
This Doesn’t Look Like Kansas Anymore
Managed care plans often have small provider networks. Fewer doctors. Fewer hospitals. The question is, how much smaller?
A Kaiser Foundation survey found that on average “Medicare Advantage plan networks included 46% of all physicians in a county.” Some plans had fewer than 5 thoracic surgeons, fewer than 5 neurosurgeons and fewer than 5 radiation oncologists.
This isn’t JUST about dollars. It is also about access to health CARE.
Each calendar year brings a new list of approved providers. Will your doctors be included or will they disappear into a dark hole?
Are you willing to change doctors to save money or pay more to keep your doctor?
Are claims submitted by non-par providers covered by your plan?
A recent government report says seniors are more likely to LEAVE managed care plans when they get sicker.
Managed care is great when you enjoy good health. But how much will your plan cost when your health changes dramatically? Can you really afford to be sick?
Medicare Advantage Final Exam
Many who enroll in a managed care plan never really understood how the plans work . . . until they had large claims. Don’t be one of them!
Do you like your current doctor(s)? Would you like to keep him or her?
Do you want to direct your own health care, pick your own doctors and hospitals, or would you rather let an insurance carrier do that for you?
Is it easier for you to budget $120 per month to cover almost all of your health care costs or are you OK paying for your health care only as needed?
Could you budget $6,000 per year or more for your health care (not including drugs) if you had to?
How long could you afford to pay that much? One year? Two years? Longer?
You can change your Advantage plan every year. Same is true for your drug plan. You can also enroll in original Medicare any time you want without answering health questions.
But if you want to change to a Medicare supplement plan you may need to prove you are healthy. Your best shot at getting a Medicare supplement plan is when you first enroll in Medicare Part B. If you wait until you NEED a Medigap plan you may not be able to get one. That is Catch-22.
Many will only have one chance to enroll in a Medigap plan. Will you be one of them?
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